Tax Planning as a Strategy for Financial Optimization of a Dermatology Medical Clinic

Luisa de Lima Serafim; Raissa Silveira de Farias

DOI: 10.22167/2675-6528-202603190

Article derived from a Course Conclusion Work (TCC), with content based on the student’s original work and adapted to the editorial format of the E&S Magazine with the support of the ResumeAI tool, an artificial intelligence solution developed by Instituto Pecege for textual synthesis and organization.

Summary

This study analyzed the tax burden on medical clinics, focusing on a dermatological clinic, from the perspective of controllership and finance. The objective was to identify the most suitable tax system and the possibility of equating to hospital services for financial optimization. A quantitative case study was conducted in a dermatological clinic in Mogi das Cruzes, using financial data from the fourth quarter of 2024 and 2025. Simulations compared the Simples Nacional, Presumed Profit, and Real Profit tax systems, considering scenarios with and without equating to hospital services, with Simples Nacional being excluded due to revenue limits. The results showed that the Presumed Profit tax system, combined with equating to hospital services, provided the lowest tax burden. This alternative generated an estimated reduction of R$ 229,200.00 (29.5%) compared to Presumed Profit without equating and R$ 183,360.00 (25.1%) compared to Real Profit, positively impacting the company’s profitability. It was concluded that tax planning, integrated with controllership and the correct application of legislation, is essential for the fiscal efficiency and growth of medical clinics, although the transition of the tax reform requires continuous monitoring.

Keywords: Tax burden; Medical clinics; Controller’s office; Presumed Profit; Tax planning.

1. Introduction

The health sector in Brazil presents a mixed model, characterized by the coexistence of the public system, the Unified Health System (SUS), and the private sector, which includes health plan operators, hospitals, and specialized clinics. The relevance of these activities in the Brazilian economic and social scenario is evidenced by data from the Brazilian Institute of Geography and Statistics (IBGE, 2025).

The medical demography of 2025 points to the existence of 570,000 active physicians in Brazil. Of this total, 55.4% are specialists concentrated in the private sector of the country’s southeast region, according to data from Scheffer (2025). The private sector, driven by investments in modern equipment, the presence of specialists, and sophisticated healthcare structures, demonstrates a greater capacity for offering specialized services. Additionally, data from the National Agency for Supplementary Health (ANS, 2025) indicate that health insurance plans registered more than 52 million beneficiaries, and the aging population, according to the Institute of Applied Economic Research (IPEA, 2025), contributes to the increase in demand for health services, driving the expansion of specialized clinics and services.

Given the growth of the private healthcare sector, there has been an increase in the volume of revenue generated by clinics and other medical service providers. Although this scenario represents opportunities for expansion and profitability, it also implies a greater tax burden on the activities developed. In this context, the tax burden plays a crucial role in the financial management of these organizations.

The Brazilian tax burden is recognized for its complexity and high rate, being composed of taxes collected at the federal, state, and municipal levels. Among the main taxes levied on legal entities in the health sector, the Corporate Income Tax (IRPJ), the Social Contribution on Net Profit (CSLL), the Social Integration Program (PIS), the Contribution for the Financing of Social Security (COFINS), and the Service Tax (ISS) stand out (Brazil, 1995).

A relevant legislative milestone for the sector was Law 9.249/95, which, among other aspects, established rules that allow for tax reduction for invasive services, enabling the equalization of medical clinics to hospital services for tax purposes. This equalization constitutes a tax planning strategy that can legally reduce the tax burden, directly impacting the profitability of organizations. The controller’s role thus becomes fundamental in the analysis and adequate classification of business activities.

Despite the sector’s relevance, the diversity of health establishment classifications in the National Registry of Health Establishments (CNES), maintained by the Department of Informatics of the Unified Health System (DATASUS), makes it difficult to isolate the measurement of the number of medical clinics (Ministry of Health, 2023). This complexity reinforces the need for studies that deepen the understanding of the specific tax management of these entities.

Considering the importance of tax planning for the optimization of financial results and the complexity of the fiscal system, this study directs its analysis to a dermatological clinic located in the municipality of Mogi das Cruzes, in the metropolitan area of São Paulo. The present work aims to analyze the tax burden on the Mogi das Cruzes unit, migrating from a commercial building to a new property due to high demand. The analysis is carried out by comparing financial data from the last quarter of 2024 and the last quarter of 2025.

2. Material and Methods

The present research was characterized as a case study, of an applied nature and quantitative approach. The focus of the investigation was on the analysis of the tax burden, from the perspective of controllership and finance, in a real organizational context. This type of study allowed for an in-depth understanding of the impacts of tax systems on the financial performance of a specific entity, aligning with the objective of evaluating the effects of the tax burden and tax systems on the organization’s financial performance.

The selected unit of analysis was a dermatological clinic, located in the municipality of Mogi das Cruzes, in the metropolitan area of São Paulo. The choice of this clinic was justified by its representativeness in the region’s private healthcare sector and by the possibility of direct access to financial and operational data. The clinic in question was in the process of migrating from a commercial building to a new property, driven by high service demand.

For the development of the study, internal financial data from the clinic were used, covering the last quarter of 2024 and the last quarter of 2025. The information collected included total sales, operational costs, administrative expenses, and taxes levied on the activities developed by the company. This data was considered essential for carrying out the proposed comparative analyses.

Data collection was carried out directly through the company’s internal records. The researcher, embedded in the organizational context and a participant in the management process, obtained direct access to these records. The use of the information was duly authorized by the clinic’s owner and majority partner, with a commitment to preserve the academic purpose of the research and ensure the objective analysis of the data collected.

The methodological procedure was structured in sequential steps. Initially, a survey and organization of financial data for the periods 2024 and 2025 was carried out. Subsequently, the identification of taxes applicable to the clinic’s activity was performed, considering the current tax legislation and new enactments that impact the calculation of the tax burden.

Subsequently, comparative simulations were performed between the different tax systems applicable to legal entities in Brazil: Simples Nacional, Presumed Income, and Real Income. In these simulations, the tax burden was evaluated in distinct scenarios, including the possibility of classifying the clinic as an activity equivalent to hospital services, as provided for in Law 9.249/95. This equivalence is a crucial factor for the legal reduction of the tax burden.

Additionally, the analyses considered the norms applicable to the health sector, including the guidelines of the Brazilian Health Regulatory Agency (Anvisa) and local health surveillance, which regulate the activities of medical clinics. The integration of these regulatory aspects was fundamental to contextualize the application of the tax system and the feasibility of equating them to hospital services.

From the organization and analysis of the data, the aim was to demonstrate, in a practical and well-founded way, how the choice of the tax system and the application of tax planning strategies can directly influence the clinic’s financial results. The study aimed to highlight the importance of controlling as a strategic tool in financial management and optimization, without presenting the specific results of the simulations in this section.

3. Results and Discussion

The comparative analysis of the tax burden on the dermatological clinic in Mogi das Cruzes revealed important insights into financial optimization through tax planning. The study focused on financial data from the last quarter of 2024 and 2025, evaluating the Presumed Profit and Actual Profit tax systems, as well as scenarios with and without equalization to hospital services. This approach allowed for the identification of the impact of revenue growth and different tax choices on the company’s fiscal efficiency, during a period that included the clinic’s move to a new property due to growing demand.

Initially, the Simples Nacional regime was excluded from the analysis, as the clinic’s gross revenue exceeded the maximum limit allowed for inclusion in this regime, as established by Complementary Law No. 123/2006 and its subsequent amendments. This exclusion directed the research focus to the comparison between Presumed Profit and Actual Profit, which are the most relevant regimes for larger companies in the healthcare services sector, ensuring that the simulation reflected the viable tax options for the clinic in question.

Upon analyzing the financial data, a significant growth in the clinic’s gross revenue was observed. The accumulated revenue in the fourth quarter of 2024 was R$ 1,600,000.00, while in the same period of 2025 it reached R$ 1,910,000.00. This increase represents a growth of approximately 19.4%, evidencing the expansion of the clinic’s operations. Such growth reinforces the need for a continuous evaluation of the tax framework, as the increase in revenue directly impacts the absolute values of taxes due, making tax planning even more critical for the business’s sustainability.

In the fourth quarter of 2025, the estimated tax totals for the different scenarios were R$ 776,415.00 for Presumed Profit without equalization to hospital services, R$ 730,575.00 for Real Profit, and R$ 547,215.00 for Presumed Profit with equalization to hospital services. These values clearly demonstrate that the Presumed Profit regime, when combined with equalization to hospital services, resulted in the lowest total tax burden for the clinic in the analyzed period, indicating the superiority of this fiscal strategy.

The adoption of Presumed Profit with equalization to hospital services generated an estimated tax reduction of R$ 229,200.00, which corresponds to approximately 29.5% less compared to Presumed Profit without equalization. Regarding the Actual Profit, the difference was R$ 183,360.00, representing a saving of approximately 25.1%. These results underscore the ability of tax planning to substantially influence the financial resources available to the clinic, directly impacting its profitability and investment capacity.

The equalization of medical clinics to hospital services for tax purposes, as permitted by Law 9.249/95, constitutes a tax planning strategy of great relevance. This measure allows for the legal reduction of the tax burden on invasive services, positively impacting profitability. The controller’s role is fundamental in this process, as it is responsible for the analysis and adequate classification of business activities, ensuring that the clinic benefits from legal provisions to optimize its results (Almeida and Andrade, 2015).

The findings reinforce the importance of tax planning integrated with controlling, as the choice of tax framework can produce significant effects on the tax burden and, consequently, on the organization’s financial performance. The decision of the best tax framework should not be seen merely as a legal obligation, but as a strategic management tool. This perspective aligns with the view that controlling should act as support for economic management, contributing to efficiency and profitability (Catelli, 2001).

In addition to the analysis of current tax systems, the study considered the possible future impacts of the Tax Reform. The implementation of the Contribution on Goods and Services (CBS) and the Tax on Goods and Services (IBS) will occur gradually, altering the current tax structure. The CBS will replace PIS and COFINS, while the IBS will progressively replace ISS and ICMS, representing a substantial change in the Brazilian fiscal system (Brazil, 2023; Brazil, 2025).

The transition to the new tax system is expected to occur progressively, with a defined timeline. The year 2026 marks the initial period for the implementation of the CBS and the IBS. Starting in 2027, the extinction of PIS and COFINS is scheduled, with the charging of the CBS. Between 2029 and 2032, the gradual replacement of ISS and ICMS by IBS will occur, with a growing participation of IBS and a corresponding reduction in current taxes, reaching 40% in 2032. From 2033 onwards, the new model will be in full effect, with the total extinction of ISS and ICMS (Brazil, 2023).

To illustrate the gradualness of this transition, a simulation was performed using R$ 95,500.00 of ISS as a base value, corresponding to the fourth quarter of 2025. This simulation showed that the proportional share of ISS would be reduced to R$ 85,950.00 in 2029, R$ 76,400.00 in 2030, R$ 66,850.00 in 2031, and R$ 57,300.00 in 2032, while the proportional share attributed to IBS would progressively increase. In 2033, the simulation represents the full substitution of ISS by IBS, although these values are exclusively demonstrative and not estimates of the IBS actually due.

A favorable aspect for the healthcare sector in the Tax Reform is the differentiated treatment established by Complementary Law No. 214/2025. This legislation provides for a 60% reduction in the IBS and CBS rates applicable to the healthcare services covered. Such a measure can mitigate part of the potential impact of the new consumption taxation, representing a significant benefit for medical clinics and other healthcare service providers, as indicated by the legislation (Brazil, 2025).

Possible benefits of the reform include the simplification of the tax system and increased transparency in tax assessment. However, the transition period will require adaptations in the company’s financial, accounting, and tax controls, in addition to continuous monitoring of applicable rates and conditions for the use of tax credits. Based solely on the data from this study, it is not possible to state whether the definitive implementation of the CBS and IBS will result in an increase or reduction of the clinic’s total tax burden, given the complexity and progressivity of the changes.

Therefore, although the results for the fourth quarter of 2024 and 2025 indicate greater tax efficiency under the Presumed Income regime with equalization to hospital services, the gradual implementation of the Tax Reform requires continuous monitoring. The controlling department should periodically re-evaluate the impacts of the CBS and IBS on the clinic’s tax structure, especially during the transition period until 2033, allowing for the identification of any burdens and benefits and supporting future tax planning decisions, ensuring the clinic’s adaptation and competitiveness in the new fiscal scenario.

In summary, the research demonstrated that the Presumed Profit tax system, combined with the equalization to hospital services, is the most advantageous option for the dermatological clinic studied, providing a substantial reduction in the tax burden and positively impacting profitability. The analysis reinforces the strategic importance of tax planning, integrated with controlling, as an essential tool for efficient financial management and the growth of medical clinics, especially in a scenario of constant legislative changes, such as the transition to the Tax Reform, which demands continuous monitoring and adaptation.

4. Conclusion

The present study analyzed the tax burden on a dermatological clinic, from the perspective of controllership and finance, seeking to identify the most suitable tax system and the viability of equating it to hospital services for financial optimization. It was found that the Simples Nacional regime was excluded from the analysis due to the clinic’s gross revenue limit. The comparison between Presumed Profit and Actual Profit, in scenarios with and without equating to hospital services, demonstrated that Presumed Profit, when combined with equating to hospital services, resulted in the lowest tax burden in the fourth quarter of 2025. This strategy led to an estimated reduction of R$ 229,200.00 (29.5%) compared to Presumed Profit without equating and R$ 183,360.00 (25.1%) in relation to Actual Profit, positively impacting the company’s profitability. The main contribution lies in the practical demonstration that tax planning, integrated with controllership and the correct application of legislation, is an essential strategic tool for fiscal efficiency and the growth of medical clinics.

However, the study has limitations inherent to its design, being a case study focused on a single clinic and a specific period. Although the findings indicate the superiority of Presumed Profit with equalization for the analyzed context, the gradual implementation of the Tax Reform, with the introduction of the CBS and IBS by 2033, requires continuous monitoring. It was not possible, based on the data from this study, to state whether the new tax structure will result in an increase or reduction of the clinic’s total tax burden. It is suggested that the controlling department periodically re-evaluate the impacts of CBS and IBS on the clinic’s tax structure, especially during the transition period, to identify any burdens and benefits and support future tax planning decisions, ensuring adaptation and competitiveness in the new fiscal scenario.

Bibliographic References

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Article originating from the Final Course Work of the Specialization in Finance and Controllership of the MBA USP/Esalq

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